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Very often I see patients who weight train and suffer from shoulder pain. It seems that weight lifting is a potential risk factor for shoulder injuries, most noticeably the rotator cuff, however it doesn’t have to be.

You’ve probably noticed time and time again (usually after bench or shoulder press) people standing up, rolling around a shoulder, maybe pressing around the back of the shoulder with a pained look on their face. Some people will say you have to expect shoulder aches and pain when training, especially if you use heavier weights with low reps or work to fatigue.

However this isn’t necessarily true – I aim to explain in this article how to help reduce the risk of shoulder injuries when weight training!

1) Shoulder Mobility

Keeping mobility in the shoulders is vital. Many patients I see have a loss of, or tightness into external rotation of the shoulders. To test this simply bend the elbows by your side and twist out (see below).

Make sure both sides are the same and feel the same. It’s easy to feel if the movement is tight or restricted.

It a good idea to keep a rough gauge on how much mobility you have in this movement to ensure it isn’t reducing or painful at the end of the range.

It’s good to stretch this area to keep it supple and help prevent injury. Keeping the pecs supple with stretching and some muscle energy techniques for the pecs can help increase external rotation also.

2) Scapular Control

A very common diagnosis by physiotherapists is “scapular dyskinesia” meaning the biomechanics of the shoulder blade isn’t ideal. This is a bit of a hot topic at present within my profession, in my opinion it’s important to ensure your shoulder blade is moving smoothly and fully, doing lower trapezius and lat dorsi work will help.

For example:

When doing a lat-pull down, imagine you are drawing your shoulder blades in and down, as if you were trying to touch them together. This potentially not only increases your lat recruitment but can help scapular control also.

If the bio-mechanics of the shoulder isn’t ideal it risks narrowing the subacromial space which can lead to rotator cuff irritation or “impingement” as it was once knew.

3) Thoracic Spine

The thoracic spine is the section of your back between the bottom of the neck and the start of the lumbar spine (low back). This section provides a lot of rotation; test your movement by sitting down, crossing the arms across the chest and twist to the left and then the right. Again compare both sides and see if the movement is the same and how it feels when your reach the end of the movement.

…Tight? Give it a stretch and do some mobility work!

It’s important to maintain mobility around the thoracic spine and its directly affects the shoulder mobility, if its stiff the scapular may not glide easily but perhaps more importantly you can over use the shoulder joint itself to compensate.

For example:

When doing a front raise a stiff thoracic spine may lead increased elevation of the whole shoulder girdle to compensate, this in turn can narrow the space where the rotator cuff tendons sit and again risk injury. The most simple thoracic spine mobility exercise is to sit on a stable surface arms across the chest rotate to the side and bounce at the end of the movement. Keep this section of the back mobile and it can help reduce the risk of shoulder injury.

Other ways include putting a foam roller or rolled up towel on the floor and laying on it to apply a gentle pressure on the spine and paraspinal muscles.

4) Infraspinatus

This muscle runs across the scapular and attached to the humerus, it produces lateral rotation of the shoulder. This muscle can, in my experience, contribute to a lot of shoulder issues. It gets tight and weak and is overlooked. It can develop ‘Trigger points’ (not everyone believes in this diagnosis) but tension in here can refer pain around the shoulder.

Trying to stretch this muscle can be difficult, using a massage ball or lacrosse ball against a wall can help to ‘release this’ and allow a freer shoulder movement.

Although the pressure doesn’t change the structure of the muscle I can introduce a new stimulus and so help relaxation. A potential reason for this tightness could be weakness in lateral rotation. A side laying lateral rotation with a dumbbell should be incorporated into a workout routine or as a warm exercises

5) Tight Neck

Tightness in the neck and over use of the upper fibres of trapezius can alter scapular control and shoulder movement.

Keep the neck supple with simple stretches. A lot of patient I see with neck complaints have weakness in the deep muscles of the neck, this can cause over activity in the upper traps.

To work on this chin retraction exercises work well, sit up straight and draw the chin backwards as if you were sliding the head backwards on the neck, or simply give yourself a double chin! This can work very well with neck and shoulder issues.

Take home message

✓ Training doesn’t mean you have to suffer shoulder pain

✓ Keep the neck and thoracic spine loose with simple mobility work

✓ Keep the rotation movement strong

✓ Listen to your body, sharp pains when benching, shoulder pressing etc isn’t a good sign, get it checked out early.